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Saturday, November 29, 2014

What is compliance (Medicine)?

In medicine, one speaks of compliance of the patient as a generic term for the cooperative behavior in the context of therapy. The term may be rendered "adherence". In English, the term adherence is used synonymously. Good compliance is consistent in following the medical advice. According to the World Health Organization (WHO), only 50% of patients have a good compliance on average. Particularly important is the compliance with chronic illness in terms of taking medications that following a diet or a change of lifestyle. In many therapeutic areas with chronic diseases are at one year, only about 50% of patients in the initial treatment. More broadly, it takes compliance readiness of the patient and his environment relevant to sit against the disease to fight back.

The five dimensions of compliance

The WHO defines five interlinked dimensions that influence treatment adherence:

-Socio-economic factors (poverty, educational attainment, unemployment)
-Patient-dependent factors (ability to self-organization, forgetfulness, knowledge)
-Disease-related factors (symptoms, perceived benefits, concurrent depression)
-Treatment-related factors (side effects, complexity of administration)
-Health Systems and therapist-dependent factors (cost coverage, treatment options, communication)

Measurement of compliance

The measurement of adherence to therapy is difficult. Technology and partnership can help. Is not it a scale; the measurement of adherence is an estimate of the current behavior of the patient. Measurement methods:

-In vitro diagnostics (blood)
-MEMS (electronic monitoring of the removal of capsules / tablets from a container)
-Pill counting, calculation of drug availability over time
-Monitoring the drug purchase
-Self-declaration (investigated with questions / questionnaire)
-Assessment of the physician / pharmacist (overestimation answers according to the social desirability)
-Report of kin / clinic external Nursing
-Observation of ingestion (drug rehabilitation programs, treatment of tuberculosis)

Measurements always reflect an actual behavior resist at a time and are not continuous with the exception of MEMS or directly observed ingestion. This means that treatment adherence can change over time and under different factors. Compliance is often expressed as a percentage. In many therapeutic areas is referred to as good compliance, if the observed time period 80% or more of the planned dosage was ingested. It should be noted that compliance can go from zero to about 100% - "100%" means that the patient has taken too much medication as scheduled.

Non-Compliance

Non-compliance with medical advice and the non-fulfillment of the therapeutically necessary requirements are referred to as non-compliance. Often a distinction is made between accidental and intentional non-compliance. Unintentional non-compliance is most common. The reasons for this are manifold. The main reason is, according to patients in their forgetfulness. In addition, can be the causes of non-compliance with an uncomfortable intake, side effects, stress or costs. Other important reasons are insufficient information or insufficient understanding of the disease and the possibilities and effects of the medication. These often come attitudes and beliefs that may hinder a consistent implementation of the recommendations. In many chronic diseases and lack of symptoms may be tempted not to follow the treatment consistently. However, a lack of implementation of agreements with the doctor occurs not only in relation to the medication. The reduction of risk factors such as obesity, smoking and lack of exercise is an important contribution to improving health and extending life expectancy. The reaction of the doctor's recommendations in these areas makes many people bother requires insight, breaking down barriers and often the use of professionals.

Inadequate implementation of the therapy plan may vary depending on the underlying disease, with an increased risk of death associated more disease symptoms and reduced quality of life. How could a direct correlation between mortality and reliability of medication for statins and beta-blockers are detected in patients after myocardial infarction. In addition to the reduction in life expectancy and increased symptoms also occurs to be unnecessary treatments and related costs. Thus, a certain number of hospitalizations caused by lack of implementation of treatment plans.

The number of non-complianter patients is particularly high in neurology and psychiatry. In patients with schizophrenia, depression, epilepsy, multiple sclerosis, the rate of non-Compliancer is 50 percent. According to the Psychiatric Hospital of the Technical University of Munich each second instruction in psychiatry could be prevented if patients would not sell their psychotropic drugs without authorization. But also in the other disciplines not followed approximately one third of patients the treatment plans or incorrect. According to the World Health Organization, lack of adherence to therapy is a large and global problem that affects all therapeutic areas.

Promotion of Compliance

Measures to promote compliance should be consistent with the reasons for the lack of compliance. Therefore, it is reasonable that doctor, pharmacist and patient are not just talking about the diagnosis, treatment plan and medical support, but also on the implementation of the treatment plan and the patient's ability to self-organization. It should also be clarified what the risks are in non-compliance when z. B. could happen forgetfulness most frequent reason and what measures contribute to non-compliance and to prevent recurrences. For example, should at a medication that can be anchored in hard daily routine, to search for measures that can be taken to ensure that the medication takes place at the right time in the right dosage. Particularly for drugs, where the timing of the receipt for the action is important, it should be noted (Parkinson's treatment, antibiotics, anti-HIV drugs, immunosuppressants).

Possible measures include:

-Attention to the problem of lack of adherence to therapy
-Information on the disease, the drugs and the importance of regular medication
-Simplifications of drug therapy
frequency of intake
combinations
-Organizational aids to facilitate the taking:
Pill boxes
Calendar
Anchoring in the daily routine (pack in tooth mug, magnet / sticker on the fridge, alarm clock)
Reminders in electronic calendars
Compliance Reminder systems: SMS reminders to your mobile phone
-Monitoring
Self-monitoring (high blood pressure, glucose levels, weight)
MEMS (electronic measurement of the tablets from container) - be organized only at home
Measurement of blood levels (HbA1c, cholesterol) at regular intervals by a doctor or pharmacy
-Directly observed ingestion (eg methadone program, tuberculosis treatment)

Psychological factors
To increased compliance contributes to the patient if he

-is convinced of its general susceptibility to disease,
-of his illness stops opposite for particularly vulnerable
-the seriousness of his suffering recognizes
-believes in the efficacy of the therapy,
-satisfied with the medical care is
-is supported by his family in his adherence behavior,
-does not dare not to follow the advice of the practitioner and
-aware of its weaknesses with respect to its self-organization is aware and is seeking support.

Furthermore, treatment adherence can be improved by psychoeducation.

Factors in the environment
The doctor should vote therapeutic instructions and strategies on the possibilities and wishes of the patient. For example, it is advantageous to prescribe a drug maintenance therapy combination preparations that need to be taken only once a day, instead of several times daily dosing half or even quartered tablets.

It might be helpful, here is a easy-to-open packaging and preparation of daily use by sorting into a pill or drug delivery in prepared individual packages (blister) be. And electronic systems for monitoring tablet removal and aural or visual reminder of the drug intake can be used.

Representatives of the pharmaceutical and packaging industries as well as patient organizations founded 2003, the non-profit organization Healthcare Compliance Packaging Council of Europe to support patients to administer medication through intelligent packaging design.

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